Gene/Protein Disease Symptom Drug Enzyme Compound
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 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A total of 314 immunocompromised patients with serious cytomegalovirus (CMV) infection treated with ganciclovir administered intravenously were studied. Rates of favorable clinical response among evaluatable patients were 91 (84%) of 108 for CMV retinitis, 35 (83%) of 42 for gastrointestinal CMV infection, and 26 (72%) of 36 for CMV pneumonia. Of 167 treated patients who had AIDS, improvement or stabilization of CMV disease occurred in 83% as compared with 13% of 39 untreated, historical control patients with AIDS and similar CMV disease (P less than or equal to .004). Virologic response was noted in 111 (92%) of 121 patients who had sequential cultures of blood, urine, or throat washings for CMV. In an attempt to prevent relapse of CMV disease after discontinuation of ganciclovir, maintenance treatment was evaluated in a group of 61 patients with AIDS and CMV retinitis who had received an initial dosage of greater than or equal to 7.5 mg/(kg.d) for greater than or equal to 10 days. Median time to relapse of retinitis was 47 days in patients not receiving maintenance treatment as compared with 105 days in patients treated with 25-35 mg/(kg.w) (P = .0002). Adverse effects of treatment included neutropenia (42%), thrombocytopenia (19%), central nervous system effects (18%), nausea (6%), fever (6%), rash (6%), vomiting, diarrhea, infusion site reactions, and anemia (4% each). It was concluded that ganciclovir has clinical efficacy against CMV disease, as well as an in vivo antiviral effect, and that this agent reduces morbidity of serious CMV infections in immunocompromised patients.
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PMID:Ganciclovir treatment of life- or sight-threatening cytomegalovirus infection: experience in 314 immunocompromised patients. 284 86

2 distinct human immunodeficiency viruses, HIV-1 and HIV-2 were isolated simultaneously from the blood of an Ivory Coast patient with AIDS. The HIV subtypes were segregated by their differential ability to infect established human cell lines and by the cell surface expression of type-specific viral antigens. The viruses could be distinguished by both immunoblot and Southern blot analyses. The results indicate that an individual can be infected by both HIV subtypes. The serum samples were from individuals who attended the Triechville Hospital in Abidjan, Ivory Coast. A 37-year-old woman presenting with recurrent vomiting and weight loss of 39 kg, prolonged fever, but no lymphadenopathy had both isolates. Necator americanus infection was diagnosed before she died. Altogether of 67 HIV antibody-positive samples tested to date, 23 (34%) had reactivity by both procedures to HIV-1 and HIV-2. PMC from 13 of these 23 individuals with dual reactivity were co-cultivated with PMC from normal seronegative donors. 15 of the other 22 individuals with dual antibody reactivity presented with parasitic bowel infections, chronic diarrhea and extreme weight loss; the remainder had pulmonary disease. There were no differences in clinical manifestations of individuals with dually reactive sera and of patients with antibodies specific to either HIV-1 or HIV-2 alone. However, it is not possible to assess the role of dual infection in the exacerbation of HIV associated illness as all patients in this study were selected on the basis of their clinical manifestations.
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PMID:Simultaneous isolation of HIV-1 and HIV-2 from an AIDS patient. 290 24

In a patient with AIDS, severe cytomegalovirus (CMV) infection dominated with gastro-intestinal and retinal involvement. The gastro-intestinal signs--diarrhoea and recurrent vomiting--correlated with the destruction of the tunica muscularis of the digestive tract seen at post-mortem. The CMV retinitis caused an almost complete loss of sight, the consequence of extensive destruction of the retina. In addition to the generalized CMV infection and disseminated Kaposi's sarcoma, which also involved the gastro-intestinal tract and caused discrete histopathological changes, post-mortem examination revealed a malignant lymphoma of the brain.
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PMID:[Specific gastrointestinal manifestations of a generalized cytomegalovirus infection in a patient with acquired immune deficiency syndrome]. 298 66

A study was conducted at the Ndola Central Hospital, Zambia, in 1987 to determine whether human immunodeficiency virus (HIV) infection increases the risk or severity of infection with falciparum malaria in patients aged 12 years and over. The 170 patients examined all presented with symptoms suggestive of malaria, including fever, chills, rigors, headaches, joint pains, myalgia, acute diarrhea, and vomiting. 67 (39%) were diagnosed as having falciparum malaria and 28 (17%) were positive for the HIV antibody. The prevalence of malarial parasitemia in patients with HIV antibodies was lower than that in patients without such antibodies (29% versus 42%, respectively), and differences in densities of parasites also failed to provide evidence of increased susceptibility to malaria in patients infected in HIV. There were no significant differences in antibody titers to P falciparum in patients who were positive for HIV antibody and in those who were negative, whether or not they had parasitemia. The earlier finding of a significant association between malaria and HIV infection is now believed attributable to false positive results with the 1st enzyme linked immunosorbent assays and to interpretation difficulties with the Western blot test. Of interest is the fact that 20 patients in this study had symptoms suggestive of malaria, but had negative results for parasites and positive results for HIV antibody. This indicates that many patients with HIV infection may be presenting with an illness clinically similar to malaria before acquired immunodeficiency syndrome (AIDS)-related complex or AIDS is recognizable.
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PMID:Relation between falciparum malaria and HIV seropositivity in Ndola, Zambia. 304 86

Gastrointestinal symptoms are pervasive in patients with AIDS. Organ-specific symptoms, particularly dysphagia, postprandial emesis, hematemesis, biliary colic, increasing abdominal girth, and small volume diarrhea, are usually easy to diagnose definitively and may respond to specific therapy. Thorough invasive and noninvasive investigation is warranted.
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PMID:Gastrointestinal manifestations of HIV infection. 306 May 24

A 32-year-old Haitian male with acquired immunodeficiency syndrome presented with complications of Isospora belli enteritis. Therapy with the investigational drug difluoromethylornithine was initiated. Severe thrombocytopenia, nausea, and vomiting developed during intravenous drug therapy and recurred upon rechallenge with low-dose oral difluoromethylornithine. Therapy was discontinued because of these severe adverse effects.
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PMID:Thrombocytopenia and vomiting due to difluoromethylornithine. 311 10

A 44-year-old man with acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP) who suffered adverse effects from treatment with trimethoprim-sulfamethoxazole (TMP-SMX) and was then treated with pentamidine isethionate is described, and approved and investigational drugs used in the management of PCP in the AIDS patient are discussed. After taking TMP-SMX, 240 mg trimethoprim and 1200 mg sulfamethoxazole, four times a day orally for 10 days at home, the patient was hospitalized complaining of nausea, vomiting, diarrhea, and fever. Intravenous TMP-SMX was begun at a dosage of 18 mg/kg/day of trimethoprim. Four days later, his condition had deteriorated and he had elevations of liver enzymes and a decrease in white blood cell (WBC) count. TMP-SMX was discontinued and pentamidine isethionate was started at a dosage of 4 mg/kg/day i.v. His symptoms and fever subsided and his liver enzyme levels and WBC count improved. After nine days of pentamidine his WBC count decreased; pentamidine was suspected as the cause and discontinued; no further therapy was needed. PCP was the initial infection that established this patient's diagnosis of AIDS. The patient did not have exertional dyspnea and nonproductive cough, which are usually seen in AIDS patients with PCP. TMP-SMX 20 mg/kg/day, based on the trimethoprim content, is the usual initial treatment for PCP. Adverse effects of TMP-SMX develop more frequently in AIDS patients than in non-AIDS patients with PCP. The recommended dose of pentamidine isethionate for the treatment of PCP is 4 mg/kg/day, im. or i.v. A few studies have shown good response to aerosolized pentamidine. Trials of investigational agents have excluded patients with severely compromised respiratory status; eflornithine, dapsone in combination with trimethoprim, and trimetrexate have been used. Corticosteroids should be considered a last effort until additional data are available. TMP-SMX may be used to prevent recurrence of PCP or to prevent the initial occurrence of PCP in AIDS patients. Intravenous or aerosol doses of pentamidine may be effective as prophylaxis. Sulfadoxine-pyrimethamine tried as prophylaxis produced adverse reactions. Despite its higher incidence of serious adverse effects in the AIDS population, TMP-SMX is considered preferable to pentamidine for initial therapy. Pentamidine is preferred for patients with documented allergy to TMP-SMX or failure to respond to a five- to seven-day course of TMP-SMX.
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PMID:Treatment of Pneumocystis carinii pneumonia in patients with AIDS. 313 63

The clinical symptoms and signs were assessed in 20 consecutive patients developing infection with the human immunodeficiency virus (HIV). All were male homosexuals and all presented with a glandular-fever-like illness. Changes in laboratory values were compared with findings in 40 HIV negative male homosexual controls. In the 10 patients for whom date of exposure to the virus could be established the incubation period was 11-28 days (median 14). One or two days after the sudden onset of fever patients developed sore throat, lymphadenopathy, rash, lethargy, coated tongue, tonsillar hypertrophy, dry cough, headache, myalgia, conjunctivitis, vomiting, night sweats, nausea, diarrhoea, and palatal enanthema. Twelve patients had painful, shallow ulcers in the mouth or on the genitals or anus or as manifested by oesophageal symptoms; these ulcers may have been the site of entry of the virus. During the first week after the onset of symptoms mild leucopenia, thrombocytopenia, and increased numbers of banded neutrophils were detected (p less than 0.0005). The mean duration of acute illness was 12.7 days (range 5-44). All patients remained healthy during a mean follow up period of 2.5 years. Heightened awareness of the typical clinical picture in patients developing primary HIV infection will alert the physician at an early stage and so aid prompt diagnosis and help contain the epidemic spread of AIDS.
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PMID:Clinical picture of primary HIV infection presenting as a glandular-fever-like illness. 314 67

A case of cryptococcal meningitis in a patient with the acquired immunodeficiency syndrome (AIDS) is described, as well as the epidemiology, pathogenesis, clinical manifestations, diagnosis, and therapeutic management of the disease. In July 1987 a 38-year-old white man was admitted to the hospital because of confusion, disorientation, and headache. His medical history was notable for a positive human immunodeficiency virus test. Culture of the cerebrospinal fluid was positive for Cryptococcus neoformans. The patient was started on amphotericin B 16 mg/day (0.3 mg/kg/day) intravenously and flucytosine 2 g every six hours (150 mg/kg/day) orally. Despite premedication with diphenhydramine and acetaminophen, he experienced rigors that were treated with hydrocortisone and meperidine. Three weeks later he was discharged on flucytosine 2 g orally every six hours and amphotericin B 50 mg intravenously every other day. One week later the patient developed fever and chills; blood cultures were positive for methicillin-sensitive Staphylococcus aureus, and his peripheral leucocyte count was 1.8 X 10(3)/cu mm. Flucytosine was discontinued, and he was treated with intravenous nafcillin while remaining on amphotericin B. In October the patient complained of nausea, vomiting, weakness, and agitation. A CSF latex agglutination titer for cryptococcal antigen was 1:32. He was treated with amphotericin B 50 mg daily until symptoms resolved and then continued on amphotericin B 50 mg twice weekly. Cryptococcosis is the most common life-threatening fungal infection among AIDS patients. In contrast to immunocompetent hosts, this population invariably develops disseminated disease, with 85% having meningeal involvement. The most effective therapy for cryptococcal meningitis in patients with AIDS has not been established.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Management of cryptococcal meningitis in patients with AIDS. 341 73

Eight homosexual men with the acquired immunodeficiency syndrome (AIDS) presented with clinical, biochemical, and radiologic features of stenosis of the papilla of Vater and sclerosing cholangitis. This newly recognized complication of AIDS produces abdominal pain, nausea, and vomiting and may predispose patients to superimposed bacterial cholangitis. Marked elevation of serum alkaline phosphatase levels and lesser changes in hepatic aminotransferase levels are common. Although abdominal ultrasonography and computed tomography detect ductal abnormalities, endoscopic retrograde cholangiography best shows precise ductal irregularities and provides therapeutic intervention. Prompt relief of symptoms follows endoscopic sphincterotomy, often with resolution of biochemical evidence of cholestasis. Biliary tract infection with cytomegalovirus or cryptosporidia and resultant viral or coccidial cholangitis are the proposed pathophysiologic mechanisms.
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PMID:Papillary stenosis and sclerosing cholangitis in the acquired immunodeficiency syndrome. 354 23


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